Acquisition of landmark, route, and survey knowledge in a wayfinding task: in stages or in parallel?

According to an influential concept, humans acquire spatial knowledge about their environment in three distinct stages: landmark knowledge is acquired first, then route knowledge, and finally survey knowledge. The stage concept has been challenged by studies which observed that in a wayfinding paradigm, route, and survey knowledge emerge at the same time and; therefore, were seemingly acquired in parallel. However, this experimental evidence is not conclusive because the above studies suffered from a ceiling effect. The present study was designed to overcome the ceiling effect by increasing the complexity of the wayfinding task. We asked 60 young participants to find their way through an urban environment rendered in virtual reality, and assessed their landmark, route, and survey knowledge after each of ten trials. We found that all three types of knowledge gradually increased from the first to the last trial. We further found that correlations between the three types of knowledge increased from trial to trial. This outcome disagrees profoundly with the stage concept, but is compatible with the parallel concept. Specifically, it is in accordance with the view that landmark, route, and survey knowledge are acquired by multiple overlapping and interacting processes: those processes may start out more or less independently in the first trial but, due to common constraints or synergies, may gradually increase their cooperation during subsequent trials.

Can point-of-sale nutrition information and health warnings encourage reduced preference for sugary drinks?: An experimental study.

Point-of-sale (POS) interventions that prompt consumers to more critically evaluate sugary drinks could encourage reduced consumption of these drinks and reinforce public health campaign messages. This study tested whether: (i) POS nutrition information and health warnings about sugary drinks promote healthier drink choices and (ii) impacts of prominent POS signs on drink choices vary based on participants' self-reported prior exposure to a sugary drink public health campaign. In an online experiment, 3034 Australian adults aged 18-59 years who were past-week sugary drink consumers were randomly assigned to one of five POS signage conditions (no signage (control); sugar content of specific beverages; Health Star Rating of specific beverages; generic text health warning about sugary drinks; generic graphic health warning about sugary drinks) and shown their randomly assigned POS sign alone, then alongside a drinks product display and asked to select which drink they would choose to buy. The proportion selecting a sugary drink was significantly lower among participants who viewed either the sugar content (29%), Health Star Rating (33%) or graphic health warning (34%) signs compared to those who saw no sign (43%). These effects held for participants who did not recall previously seeing the campaign; however, for participants with self-reported prior exposure to the campaign, POS signs did not promote significant reductions in sugary drink choices. POS signage has the potential to shift consumers away from choosing sugary drinks and could complement mass media campaigns by reaching people who may not otherwise be exposed to sugary drink public health messages.

Patient satisfaction with antiretroviral therapy services and associated factors at Gondar town health centers, Northwest Ethiopia: an institution-based cross-sectional study.

BACKGROUND: The Human Immunodeficiency Virus (HIV) with which over 37 million peoples are living is the leading cause of morbidity and mortality worldwide. The rapid expansion of antiretroviral treatment has dramatically reduced HIV related deaths and transmissions. Patient satisfaction could be an indispensable parameter used to measure patients' desired fulfillment by the services. Hence, this study aimed to determine the level of patient satisfaction with antiretroviral therapy services and determinants at Gondar town health centers. METHODS: An institution-based cross-sectional study was conducted from November 1 to 30, 2018. The systematic random sampling technique was used to select 663 HIV/AIDS patients on antiretroviral therapy follow-ups. Data were collected using a pretested interviewer-administered questionnaire and patient medical document reviews. Summary statistics such as means, medians and proportions were calculated and presented in the form of tables, graphs, and texts. Bivariate and multivariable logistic regression analysis was fitted and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. Variables with p-value 0.05 at multivariable logistic regression considered significant determinants of patient satisfaction. RESULTS: The overall patient satisfaction with antiretroviral therapy services was 75.4% (95%CI, 71.9 to 79%). Patients' age 38-47 years (AOR = 5.90, 95%CI: 3.38,10.31) and ≥ 48 years (AOR = 2.66, 95%CI:1.38,5.12), absence of signs and directions to ART clinic (AOR = 0.53,95%CI:0.35,0.82), Azezo health center (AOR = 2.68,95%CI:1.47,4.66) and Teda health center (AOR = 4.44,95%CI:1.73,11.30), and travel that took more than 1 h (AOR = 0.56;95% CI:0.32,0.97) were determinants of patient satisfaction with the services. CONCLUSION: The overall patient satisfaction with antiretroviral therapy service was lower than the national target of 85% with the marked difference among health centers. Older age, absence of signs and directions to ART clinics, and longer travel from home to health centers were factors influencing patient satisfaction with antiretroviral treatments. This suggests that further improvement of accessibility is likely needed to increase patient satisfaction.

Effects of Semantic Congruence on Sign Identification: An ERP Study.

OBJECTIVE: The purpose of this study was to investigate the effects of semantic congruence and incongruence on sign identification by using event-related potentials (ERPs). BACKGROUND: Sign systems have crucial roles in public spaces and traffic facilities. Poorly designed signs can easily confuse pedestrians and drivers and reduce the efficiency of public activities and urban administration. METHOD: Thirty-one participants completed a sign identification experiment independently in a laboratory setting. Experimental materials were selected from GB/T 10001, a Chinese national recommendation standard that is officially named Public Information Graphical Symbols for Use on Signs. All ERP data were processed using MATLAB 13b, and behavioral data were analyzed using Stata 14. RESULTS: N170, P200, N300, and N400 components were induced during semantic processing. Statistical analysis revealed that semantic congruence has a main effect on N300 in the frontal region and has a main effect on N400 at FZ in the frontal region, CPZ in the parietal-central region, and PZ in the parietal region. Amplitudes of N300 induced by picture-word matching were considerably different between the two experimental conditions at electrodes FZ and FCZ. Amplitudes of N400 were significantly larger in the incongruent condition than in the congruent condition. CONCLUSION: The study demonstrated that N300 and N400 are promising indicators for measuring semantic congruence in future sign design. APPLICATION: Our findings provide ERP indicators for measuring the semantic congruence of sign design, which can be easily applied to improve the efficiency of sign design and sign comprehension.

Rethinking safety in numbers: are intersections with more crossing pedestrians really safer?

OBJECTIVE: To advance the interpretation of the 'safety in numbers' effect by addressing the following three questions. How should the safety of pedestrians be measured, as the safety of individual pedestrians or as the overall safety of road facilities for pedestrians? Would intersections with large numbers of pedestrians exhibit a favourable safety performance? Would encouraging people to walk be a sound safety countermeasure? METHODS: We selected 288 signalised intersections with 1003 pedestrian crashes in Hong Kong from 2010 to 2012. We developed a Bayesian Poisson-lognormal model to calculate two common indicators related to pedestrian safety: the expected crash rate per million crossing pedestrians and the expected excess crash frequency. The ranking results of these two indicators for the selected intersections were compared. RESULTS: We confirmed a significant positive association between pedestrian volumes and pedestrian crashes, with an estimated coefficient of 0.21. Although people who crossed at intersections with higher pedestrian volumes experienced a relatively lower crash risk, these intersections may still have substantial potential for crash reduction. CONCLUSIONS: Conclusions on the safety in numbers effect based on a cross-sectional analysis should be reached with great caution. The safety of individual pedestrians can be measured based on the crash risk, whereas the safety of road facilities for pedestrians should be determined by the environmental hazards of walking. Intersections prevalent of pedestrians do not always exhibit favourable safety performance. Relative to increasing the number of pedestrians, safety strategies should focus on reducing environmental hazards and removing barriers to walking.

Implementation phase of the Tobacco-Free Parks Ordinance: a policy evaluation using photographic data.

OBJECTIVE: Mecklenburg County (Charlotte, North Carolina) Board of County Commissioners took the unique step of passing a Tobacco-Free Parks Ordinance designating most county parks as tobacco-free including all smoking products, smokeless tobacco, and e-cigarettes. The objective of the baseline phase of the Ordinance evaluation sought to assess whether signage in the parks was associated with the presence of tobacco-use litter. STUDY DESIGN: A qualitative study was conducted with photography as the method of observation across Mecklenburg County parks in North Carolina. METHODS: A representative sample of 42 parks was selected from the 186 county park properties. Photographs were taken at a list of specific types of locations within each park, with attention to signage and tobacco-use litter (butts, e-cigarette). RESULTS: Tobacco-use evidence was mostly found in parks' picnic areas (67%) and walking trails (67%), with least found in parks' athletic courts (23%). At least 80% of parks have some tobacco litter. Evidence of tobacco use was not significantly associated with signage. CONCLUSION: Little research has focused on the effect of local public policies limiting tobacco use in public outdoor spaces. Findings from this evaluation have potential to inform policy implementation efforts regarding efforts to limit tobacco use in public spaces.

Implementing the Lever Sign in the Emergency Department: Does it Assist in Acute Anterior Cruciate Ligament Rupture Diagnosis? A Pilot Study.

BACKGROUND: Within the emergency department (ED) setting, anterior cruciate ligament (ACL) rupture is commonly misdiagnosed, leading to improper treatment and potential meniscal injury and total joint replacement. Utilizing traditional clinical tests to diagnosis ACL rupture leads to the correct diagnosis in about 30% of cases. The lever sign is a new and effective clinical test used to diagnose ACL rupture with 100% sensitivity. OBJECTIVE: We aim to study if the lever sign used in the ED setting is more sensitive to diagnose ACL rupture than traditional tests. METHODS: Patients between 12 and 55 years of age were examined utilizing either traditional methods or the lever sign. Diagnostic findings in the ED were compared with those of a sports medicine specialist using magnetic resonance imaging as the diagnostic standard. A survey was given to ED providers to collect data on diagnosis and physician confidence in diagnosis. RESULTS: The sensitivity of the lever sign was 100% (94.7% accuracy, 93.75% specificity), whereas the sensitivity of the anterior drawer/Lachman test was 40% (87.5% accuracy, 100% specificity). Physician confidence in diagnosis was higher utilizing the lever sign vs. the anterior drawer/Lachman test at 8.45 (±1.82) compared with 7.72 (±1.82) out of 10, respectively. There was no statistically significant association between diagnostic accuracy with either test and level of training of the ED provider. CONCLUSION: Implementation of the lever sign in the ED setting resulted in a higher sensitivity, higher physician confidence in screening test diagnosis, and a decrease in the number of undiagnosed ACL ruptures.

Expert evaluation of traffic signs: conventional vs. alternative designs.

Traffic sign comprehension is significantly affected by their compliance with ergonomics design principles. Despite the UN Convention, designs vary among countries. The goal of this study was to establish theoretical and methodological bases for evaluating the design of conventional and alternative signs. Thirty-one conventional signs and 1-3 alternatives for each conventional sign were evaluated for their compliance with three ergonomics guidelines for sign design: physical and conceptual compatibility, familiarity and standardisation. Twenty-seven human factors and ergonomics experts from 10 countries evaluated the signs relative to their compliance with the guidelines. Analysis of variance across alternatives revealed that for 19 of the 31 signs, an alternative design received a significantly higher rating in its ergonomics design than the conventional sign with the same meaning. We also found a very high correlation between the experts' ratings and comprehension from previous studies. In conclusion, many countries use signs for which better alternative designs exist, and therefore UN Convention signs should be re-examined, and ergonomics experts evaluation can serve as a good surrogate for road users' comprehension surveys. Practitioner summary: This study presents theoretical and methodological bases for evaluating the design of UN Conventional and alternative traffic signs. Human factors and ergonomics experts evaluated 31 conventional and 68 alternative road signs, based on ergonomics principles for sign design. Results indicated the need to re-examine poorly designed UN Convention signs.

Political discourse in the hospital heterotopia.

To what extent do we pay attention to the text and images that cover our hospital walls and do we offer any critique either as professionals or service users? In the past we might have expected to see functional or helpful instructions about where to go (or not to go) and in more well-endowed buildings, perhaps we would see some works of art, sculpture, stained glass even, with the intention to encourage, distract or even forewarn us. However, it is now common in UK hospitals, for wall space to be used as a  portal for a range of institutional political messages, that convey information about everything from its own values, behaviours to  advertisements for products and services to requirements for rule following. Michel Foucault's ideas about Heterotopic space can help us to see that hospitals tend to fall (awkwardly) between being a public and personal health care space, and this is a possible explanation for the confused material culture and messages that are shared there. This paper draws on ethnographic methods to reflect on personal experience in order to offer a critique of the contemporary political discourse which has become 'literally' written onto our hospital walls.

Smoke-free signage in public parks: impacts on smoking behaviour.

OBJECTIVE: Behavioural interventions, such as smoke-free signage, are used to support air quality in public outdoor spaces that are not protected by a smoke-free policy, such as states with preemptive clause legislation. However, there is little evidence of the effectiveness of these interventions. This paper is an evaluation of whether smoke-free signage posted in public parks altered smoking behaviours of park patrons. METHODS: A time-series quasi-experimental design was used. Cigarette butts were collected at the same day and time every week in ten amenities within four parks in 2011. Each park completed a baseline period until a stable trend emerged at six weeks, then received smoke-free signage for the six week intervention period. There were 1684 cigarette butts collected during baseline and 1008 collected during the intervention phase. FINDINGS: Wilcoxon signed-rank test demonstrated that smoking at seven out of ten amenities decreased and the overall decrease was significant at p=0.028. Individual parks and amenities grouped by type did not experience a statistically significant change. A neighbourhood median income trend was visually discovered, revealing that as income increased, there was a greater decrease in cigarette butts. CONCLUSIONS: This study provides evidence on the impact of smoke-free signage not supported by local ordinance in public parks using a reproducible measure. States, especially those with a preemptive clause legislation, may benefit from incorporating smoke-free signage in public areas to protect community members from exposure to tobacco smoke, reduce littering, and denormalise smoking.

[Introduction of the development of the mo- bile smartphone application, "PWH easyGo" to help patients and visitors to navigate differ- ent departments and facilities on the hospital premises with ease].

"PWH easyGo" is a mobile smartphone application (app) designed to help patients and visitors to look for different departments and facilities on the hospital premises. Posters with QR code are displayed at various hospital entrances. Users with the app installed can scan the QR codes printed on posters on site or manually select their current locations and destinations in the app, and the system will display the relevant routes with photos. It is the first such app developed by the Hong Kong Hospital Authority and is available for download at Apple store (iOS version) and Play Store (Android version).

Stair-use interventions in worksites and public settings - a systematic review of effectiveness and external validity.

OBJECTIVE: We performed a literature review with the main aims to propose an updated overview of the effectiveness of stair-use interventions and to determine the most effective type of intervention. METHODS: We systematically searched stair-use interventions performed in worksites or public settings, published up to mid 2013. We used a harvest plot approach to visualize the findings in addition to a quantitative synthesis. We also assessed external validity using the Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS: Of 8571 articles identified, 50 were included. In worksites (25 studies) and public settings (35 studies), an increase in stair climbing was found during the intervention period in 64% and 76% of studies, respectively. Combining motivational and directional signs in worksites or conducting a second intervention phase in public settings increased stair climbing in 83% and 86% of studies, respectively. Elements of external validity were overall largely under-reported. CONCLUSION: There is evidence that stair-use interventions are effective to increase stair climbing in public settings, but evidence of such effect is limited in worksites. Issues regarding the best sequencing of interventions or the potential importance of environmental interventions should be addressed in future studies. Process evaluation should be an integral part of interventions.

Assessing the physical activity environment in Mexican healthcare settings.

OBJECTIVE: To assess the informational, educational and instrumental environments among Mexican healthcare settings for their potential to promote physical activity (PA). MATERIALS AND METHODS: The Environmental Physical Activity Assessment Tool for Healthcare Settings (EPATHS) was developed to assess the PA environments of 40 clinics/hospitals representing the three Mexican healthcare systems in Guadalajara. The EPATHS assessed the presence and quality of PA enhancing features in the informational (e.g. signage), educational (e.g. pamphlets), and instrumental (e.g. stairs) environments of included clinics/hospitals. RESULTS: 28 (70%) clinics/hospitals had more than one floor with stairs; 60% of these had elevators. Nearly 90% of stairs were visible, accessible and clean compared to fewer than 30% of elevators. Outdoor spaces were observed in just over half (55%) of clinics/hospitals, and most (70%) were of good quality. Only 25% clinics/hospitals had educational PA materials. CONCLUSIONS: The PA instrumental environment of Mexican healthcare settings is encouraging. The informational and educational environments could improve.

Health literacy environmental scans of community-based dental clinics in Maryland.

OBJECTIVES: We conducted health literacy environmental scans in 26 Maryland community-based dental clinics to identify institutional characteristics and provider practices that affect dental services access and dental caries education. METHODS: In 2011-2012 we assessed user friendliness of the clinics including accessibility, signage, facility navigation, educational materials, and patient forms. We interviewed patients and surveyed dental providers about their knowledge and use of communication techniques. RESULTS: Of 32 clinics, 26 participated. Implementation of the health literacy environmental scan tools was acceptable to the dental directors and provided clinic directors with information to enhance care and outreach. We found considerable variation among clinic facilities, operations, and content of educational materials. There was less variation in types of insurance accepted, no-show rates, methods of communicating with patients, and electronic health records use. Providers who had taken a communication skills course were more likely than those who had not to use recommended communication techniques. CONCLUSIONS: Our findings provide insight into the use of health literacy environmental scan tools to identify clinic and provider characteristics and practices that can be used to make dental environments more user friendly and health literate.

Monitoring smoke-free laws in restaurants and educational institutions in Chennai, India.

BACKGROUND: Smoking tobacco affects the health of smokers as well as non-smokers who are exposed to secondhand smoke. The Government of India enacted the Cigarettes and Other Tobacco Products Act in 2003, which included a ban on smoking in public places and on sale of tobacco around educational institutions. We assessed the extent of compliance with these laws in restaurants and educational institutions in Chennai, Tamil Nadu, India. METHODS: We conducted a cross-sectional survey using an observation checklist in restaurants and educational institutions in Chennai. We used cluster sampling for restaurants and random sampling for schools and colleges. We collected data regarding the signage displaying prohibition of smoking as per the law and sale of tobacco products around educational institutions. We estimated the proportions for various indicators. RESULTS: Among the 400 restaurants surveyed, 371 (92.8%) did not have any signage displaying prohibition of smoking and of the 29 restaurants with signage, only 4 were as per the specifications. There were 62 (15.5%) smoking events in restaurants at the time of visit for survey. Among the 287 schools surveyed, only 8 (2.8%) had the signage displaying prohibition of smoking and 2 (0.7%) had the signage for ban on sale of tobacco products. Of the 54 colleges surveyed, 8 (14.8%) had the signage displaying prohibition of smoking and 7 (13%) had the signage for ban on sale of tobacco products. CONCLUSION: There was low compliance of smoke-free laws in restaurants and educational institutions in Chennai. We recommend a robust monitoring mechanism to ensure the enforcement of smoke-free laws in public places.

Effects of competing environmental variables and signage on route-choices in simulated everyday and emergency wayfinding situations.

This study examined the relative influence of environmental variables (corridor width and brightness) and signage (directional and exit signs), when presented in competition, on participants' route-choices in two situational variables (everyday vs. emergency), during indoor wayfinding in virtual environments. A virtual reality-based methodology was used. Thus, participants attempted to find a room (everyday situation) in a virtual hotel, followed by a fire-related emergency egress (emergency situation). Different behaviours were observed. In the everyday situation, for no-signs condition, participants choose mostly the wider and brighter corridors, suggesting a heavy reliance on the environmental affordances. Conversely, for signs condition, participants mostly complied with signage, suggesting a greater reliance on the signs rather than on the environmental cues. During emergency, without signage, reliance on environmental affordances seems to be affected by the intersection type. In the sign condition, the reliance on environmental affordances that started strong decreases along the egress route.

[A survey about client orientation and wayfinding in Chilean hospitals]. / Percepción de la señalización y orientación espacial de los usuarios de tres complejos hospitalarios de Santiago, Chile.

BACKGROUND: Sense of orientation in hospitals can be tricky considering the large extension of buildings and the inadequate signage. AIM: To report some of the findings of a larger research project on wayfinding and patient navigation in Chilean hospitals. MATERIAL AND METHODS: Five hundred nine hospital users waiting for attention in three hospitals were contacted and asked to answer a survey that lasted 10 minutes, about wayfinding and sense of orientation within the hospital. RESULTS: Users declared to have a good opinion of existing signage in the three hospitals analyzed as well as their architectural organization in terms of their capacity to orient people. However, the vast majority of users asked for directions to navigate within the hospital to staff and medical personnel. CONCLUSIONS: Patient navigation problems are imposing a great "hidden" cost to hospitals management due to missed appointments.

First impressions: towards becoming a health-literate health service.

A 'health-literate organisation' recognises that miscommunication is very common and can negatively affect consumer care and outcomes, and makes it easier for people to navigate, understand, and use health information and services. This paper reports on the First Impressions Activities conducted by consumers to assess aspects of the literacy environment of a rural health service. The First Impressions Activities consists of three tools to assist health services to begin to consider some of the characteristics of their organisation that help and hinder a consumer's ability to physically navigate their way to and about the health service. The results show that navigation to and within the rural health service was made more complex due to lack of information, difficulty finding information, inconsistent terminology used in signage, missing signage, signage obscured by foliage, and incorrect signage.

A study on the visual recognition patterns of multi-information guide signs based on eye movement data analysis.

A two-factor experiment was devised to assess the appropriateness of the quantity and arrangement of information on multi-information guide signs at unique, spacious exits on elevated expressway sections. This experiment investigated 77 signs containing varying amounts of road name information and different placements of destination road names. The research entailed an indoor experiment that incorporated eye-tracking technology and involved the analysis of a total of twenty-eight indicators. A comprehensive index system was developed, identifying three key aspects: visual recognition efficiency, visual recognition difficulty, and visual fatigue. Utilizing repeated measure analysis of variances, the impact of these two factors was examined to identify significant indicators and establish a comprehensive assessment indicator system. The Technique for Order of Preference by Similarity to Ideal Solution method, in conjunction with the coefficient of entropy weight, was employed to assess the effectiveness of these two factors. The findings demonstrated that the 28 eye-movement indicators utilized in this study effectively constitute a valuable indicator system for evaluating drivers' visual recognition characteristics. These indicators capture the subtle psychophysical traits inherent in the process of recognizing signs, including visual recognition efficiency, difficulty, and fatigue. Regarding the first experimental factor, the number of sign road names significantly influences drivers' visual recognition characteristics (Sig < 0.05). Specifically, an increase in the number of sign road names leads to diminished visual recognition efficiency and heightened visual recognition difficulty and fatigue. Consequently, it is advisable to restrict the number of sign road names to a maximum of six per sign under typical circumstances, with nine being the limit under special conditions. As for the second experimental factor, the placement of the destination road name within the sign layout exerts a significant impact on visual recognition characteristics (Sig < 0.05). Each type of multi-information sign exhibits a distinct visual recognition pattern. Generally, the upper portion of the sign is more easily recognized, while the lower part poses greater recognition challenges. Therefore, to mitigate visual recognition risks, it is recommended that road information placement be prioritized based on actual usage conditions.